AIM: To review the clinical presentation and surgical management of complicated hydatid cysts of the liver and to assess whether conservative surgery is adequate in the management of complicated hydatid cysts of liver...AIM: To review the clinical presentation and surgical management of complicated hydatid cysts of the liver and to assess whether conservative surgery is adequate in the management of complicated hydatid cysts of liver.METHODS:The study was carried out at Sher-i-Kashmir Institute of Medical Science,Srinagar,Kashmir,India.Sixty nine patients with hydatid disease of the liver were surgically managed from April 2004 to October 2005 with a follow up period of three years.It included 27 men and 42 women with a median age of 35 years.An abdominal ultrasound,computed tomography and serology established diagnosis.Patients with jaundice and high suspicion of intrabiliary rupture were subjected to preoperative endoscopic retrograde cholangiography.Cysts with infection,rupture into the biliary tract and peritoneal cavity were categorized as complicated cysts.Eighteen patients(26%)had complicated cysts and formed the basis for this study.RESULTS:Common complications were infection(14%),intrabiliary rupture(9%)and intraperitoneal rupture(3%).All the patients with infected cysts presented with pain and fever.All the patients with intrabiliary rupture had jaundice,while only four with intrabiliary rupture had pain and only two had fever.Surgical procedures performed in complicated cysts were:infection-omentoplasty in three and external drainage in seven;intrabiliary rupture-omentoplasty in two and internal drainage in four patients.Two patients with intraperitoneal rupture underwent external drainage.There was no mortality.The postoperative morbidity was 50%in complicated cysts and 16%in uncomplicated cysts.CONCLUSION:Complicated hydatid cyst of the liver can be successfully managed surgically with good long term results.展开更多
To date, the efficacy of radical surgery （RS） versus conservative surgery （CS） for liver hydatid cysts （LHC） remains controversial. This meta-analysis was conducted to compare the two interventions. PubMed, Emba...To date, the efficacy of radical surgery （RS） versus conservative surgery （CS） for liver hydatid cysts （LHC） remains controversial. This meta-analysis was conducted to compare the two interventions. PubMed, Embase, and Web of Science were searched from their inceptions until June 2016. Meta-analysis was performed using STATA 12.0 software. We identified 19 eligible studies from 10 countries by retrieval. In total, 1853 LHC patients who received RS were compared with 2274 patients treated by CS. The risk of postoperative overall complication, biliary fistula, and recurrence was significantly lower, and operation time was significantly longer in the RS group. However, no statistically significant differences were found in terms of mortality risk and the duration of hospital stay between RS and CS. No significant publication biases were observed in all the above analyses. In conclusion, RS reduces the rates of postoperative complications and recurrence, whereas no trend toward such a reduction in mortality was observed in LHC patients.展开更多
文摘AIM: To review the clinical presentation and surgical management of complicated hydatid cysts of the liver and to assess whether conservative surgery is adequate in the management of complicated hydatid cysts of liver.METHODS:The study was carried out at Sher-i-Kashmir Institute of Medical Science,Srinagar,Kashmir,India.Sixty nine patients with hydatid disease of the liver were surgically managed from April 2004 to October 2005 with a follow up period of three years.It included 27 men and 42 women with a median age of 35 years.An abdominal ultrasound,computed tomography and serology established diagnosis.Patients with jaundice and high suspicion of intrabiliary rupture were subjected to preoperative endoscopic retrograde cholangiography.Cysts with infection,rupture into the biliary tract and peritoneal cavity were categorized as complicated cysts.Eighteen patients(26%)had complicated cysts and formed the basis for this study.RESULTS:Common complications were infection(14%),intrabiliary rupture(9%)and intraperitoneal rupture(3%).All the patients with infected cysts presented with pain and fever.All the patients with intrabiliary rupture had jaundice,while only four with intrabiliary rupture had pain and only two had fever.Surgical procedures performed in complicated cysts were:infection-omentoplasty in three and external drainage in seven;intrabiliary rupture-omentoplasty in two and internal drainage in four patients.Two patients with intraperitoneal rupture underwent external drainage.There was no mortality.The postoperative morbidity was 50%in complicated cysts and 16%in uncomplicated cysts.CONCLUSION:Complicated hydatid cyst of the liver can be successfully managed surgically with good long term results.
基金This research was supported by the National Natural Science Foundation of China （No. 81600452） and the Science and Technology Innovation Fund Project of Anhui Province （No. 1501041155）.
文摘To date, the efficacy of radical surgery （RS） versus conservative surgery （CS） for liver hydatid cysts （LHC） remains controversial. This meta-analysis was conducted to compare the two interventions. PubMed, Embase, and Web of Science were searched from their inceptions until June 2016. Meta-analysis was performed using STATA 12.0 software. We identified 19 eligible studies from 10 countries by retrieval. In total, 1853 LHC patients who received RS were compared with 2274 patients treated by CS. The risk of postoperative overall complication, biliary fistula, and recurrence was significantly lower, and operation time was significantly longer in the RS group. However, no statistically significant differences were found in terms of mortality risk and the duration of hospital stay between RS and CS. No significant publication biases were observed in all the above analyses. In conclusion, RS reduces the rates of postoperative complications and recurrence, whereas no trend toward such a reduction in mortality was observed in LHC patients.
